; Durable Power of Atty - Medical Care Only
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Durable Power of Atty - Medical Care Only

VIEWS: 53 PAGES: 3

Durable Power of Attorney, limited to provisions for health care and extraordinary care.

More Info
  • pg 1
									            DURABLE POWER OF ATTORNEY – MEDICAL CARE
                                (Declaration of Intent Regarding
                                 Medical Care and Treatment)



                           KNOW ALL MEN BY THESE PRESENTS:
       That I, ______________, birth date __________, Social Security Number __________,
domiciled in _______ County, _______, mailing address _______________________, do make,
constitute and appoint ________________, (Address and Phone Number), as my true and lawful
attorney-in-fact, for me and in my name, place and stead, to do and to perform any and all of the
actions which follow.


                                         MEDICAL CARE
       To make or modify any and all arrangements deemed appropriate and in my best interest
for my medical and health care; to authorize, consent or request for me and in my name, or
withhold my consent, that I be admitted as a patient in any care facility, nursing care facility,
hospital, clinic, or other medical facility as selected by my attorney-in-fact; and to give consent
for me and in my place and stead to and for any type of surgical or medical treatment or
procedures, to conse
								
To top